HomeMy WebLinkAbout034613 - Electric (temp pole) 6' o/
416.) CITY OF OSHKOSH N2 34613
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC VIPLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 221 f A,U/t/r- /M41/1/11J PLAN NO.
OWNER c_Pield t: (f7 //,~e j
DESIGNER
USE/NATURE OF WORK ( 6 / (le'
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ NC ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR F e`
Electric Serv. New ❑ Change ❑ TemppgIl Type 0/1 Volts/Xdi Amps /erg
Sill)__..._
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuatio $ 4,0`---- Permit Fee Paid $ Park Dedication $
ISSUED BY Date 6 _X "f5 Final/O.P. S " ?_3
In the performance of t ' work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE </l-c.
AGENT/OWNER DAT
ADDRESS
TELEPHONE#
04 ,
P!RMIT
No,
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Ot 414, , ,. .,,,_.4.,
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ADDRESS
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1'URE OF -�/ '/ :'
WORK �_ "
AFC. SERV. NEW
F X S TYPE o GE
APPLIANCES SW'S -.4. VOLTS -T TEl+ P•
RECEPT'S o AMPS
SIGNS ' CIRC'S
INSP. ROUGAIN
EST.EST. COST "' zei r
CS �-- SERVICE
PERMIT FEET $` FINA,
DATEy�